Subject Access Request Form


 

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Access Request Form: Request for a copy of Personal Data

 

Important: In order for us to deal with your request efficiently a copy of your proof of identity (e.g. passport or driver’s licence) should accompany this Access Request Form.  Please note that we have the right to require that you identify yourself before we will respond to any access request (see Note below).

 


 

Section A

 

Full Name…………………………………………………………….

 

Postal address*

…………………………………………………………………………

…………………………………………………………………………

…………………………………………………………………………

* Where you would like us to send you a copy of your Personal Data by post, a copy of your proof of address (e.g. utility bill) should accompany this Access Request Form.

 

Telephone/e-mail*

…………………………………………………………………………(include area code)

 

*You do not have to provide us with your telephone number and / or email address. It is advisable to supply a telephone number and / or email address in order to facilitate DLDC contacting you so that any clarifications can efficiently be made where necessary in relation to your request.

 


 

Section B

 

I, …………………………………………………..[insert name] wish to have access to Personal Data that I believe DLDC retains on me as outlined below (to assist us in efficiently dealing with your request, please include the name of service(s) and any reference number relevant to your access request):

………………………………………………………………………..………………………………………………………………………………………………………………..………………………………………………………………………………………………………………..………………………………………………………………………………………………………………..………………………………………………………………………………………………………………..………………………………………………………………………………………………………………..………………………………………………………………………………………………………………..………………………………………………………………………………………………………………..………………………………………

………………………………………………………………………..………………………………………

 

Signed……………………………………………..Date………


 


 

Checklist:  Have you: Yes No
1)  attached a copy of proof of your identity?
2)  attached a copy of proof of your address? (where you would like to send a copy of your Personal Data by         post)
3)  signed and dated the Access Request Form?

 

Please note that we have the right to require that you identify yourself before we will respond to any access request.


 

Who Do I Send My Request to:

 

Please return this form:

  • to the Data Controller. DLDC, 1 Millennium Court, Pearse Road, Letterkenny, Co Donegal
  • by e-mail to datacontroller@dldc.org  If you make a request by email, the information requested will be provided to you in electronic form (where possible), unless you request otherwise.

 

Note: we require proof of the applicant’s identity and address to ensure that the person making this access request is acting legitimately.

 


 

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